BRIGHAM AND WOMEN S FAULKNER HOSPITAL ADULT INPATIENT PSYCHIATRY ADVANCED PRACTICUM TRAINING PROGRAM

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1 BRIGHAM AND WOMEN S FAULKNER HOSPITAL ADULT INPATIENT PSYCHIATRY ADVANCED PRACTICUM TRAINING PROGRAM Christopher AhnAllen, Ph.D. Director of Inpatient Psychology and Psychology Education 1153 Centre Street Jamaica Plain, MA

2 Brigham and Women s Faulkner Hospital Training Overview: The psychology advanced practicum training program at Brigham and Women s Faulkner Hospital (BWFH) is designed to provide 3 rd or 4 th year doctoral students in psychology with an enriching 9-month (September through May) placement to develop expertise in psychological assessment and treatment within an acute inpatient psychiatry service. The program is for advanced practicum students who can commit to a 3 or 4-day training schedule for a total commitment of 20-hours each week. Provision of psychological services for patients within an acute inpatient setting is a unique opportunity to care for those with serious mental illness, dual diagnostic illnesses, and complex medical and psychiatric problems within a locked unit. BWFH provides training for one psychology practicum student each academic year. The inpatient psychiatry service also provides psychology internship training for two predoctoral psychology interns through the APA-accredited William James College Internship Consortium in Clinical Psychology. Additionally, there are two psychology practicum students at our outpatient psychiatry service (Brigham Psychiatric Specialties). BWFH s Department of Psychiatry is highly invested in the provision of 2

3 education across disciplines and psychology practicum students gain expertise in an interprofessional setting alongside social work interns, psychiatry residents, medical students, physician assistant students, nursing students and occupational therapy students. Setting: Brigham and Women s Faulkner Hospital, a community academic teaching hospital affiliated with Harvard Medical School and a member of Partners Healthcare, is located within the Allandale Woods neighborhood of Jamaica Plain, MA. The inpatient psychiatry service (2 South unit) provides acute inpatient psychiatric care to all Brigham and Women s Faulkner Hospital patients including the transfer of Brigham and Women s Hospital patients from the Longwood main campus. In addition, the 2 South unit provides care for patients who present for admission to the hospital at various other locations outside the BWH network of facilities. The 2 South inpatient unit has a capacity to provide care for up to 24 adult individuals within a locked unit. Patients are provided with either single or double-occupancy rooms with private or semi-private bathrooms. The unit provides care for adults of all gender identity and strives to be attentive to the needs of diverse persons. The unit provides a large living room with access to art supplies, recreational activities, sensory space, kitchen, and laundry. Two gathering spaces are dedicated for psychotherapy and occupational therapy groups including audiovisual technological upgrades. The inpatient unit provides an array of daily activities (see sample psychosocial programming schedule below) provided by multiple disciplines including nursing, occupational therapy, chaplain services, social work, and psychology. We also host multiple volunteers who provide peer support, music performances, and pet therapy. New additions to our programming include a trauma-informed yoga program in partnership with social work service and multiple peer-recovery services by both a parttime certified peer specialist and peer volunteer. Interview rooms with stowaway 3

4 computers are used for individual and family meetings. The unit renovation was completed in 2018 to expand the number of single occupancy beds, add a secure outdoor terrace and provide aesthetic updates throughout. Clinical Training Activities The training year is divided into two 4.5-month segments with unique training activities within each segment. Division of activities in each segment is designed to provide the practicum student with myriad opportunities to develop expertise in developing interprofessional relationships in different treatment teams, individual psychotherapy, group psychotherapy and assessment training. Interdisciplinary Treatment Team: The practicum student is assigned to an interdisciplinary treatment team that is led by an attending psychiatrist and social worker. The team also includes a staff nurse, mental health worker and may be attended by a staff occupational therapist. Additional trainees are part of the team as described above. Treatment teams coordinate the assignment of the roles of primary therapist and family worker. These roles are continued for each patient throughout their hospitalization and are assigned to all primary team members. Treatment teams meet daily and plan care each day for each patient as is needed on an acute unit. Ad hoc meetings with the team are also common to coordinate acute treatment, family meetings with patients and discharge planning. 4

5 Individual Psychotherapy: Practicum students will provide primary individual psychotherapy for patients on their treatment team. Individual psychotherapy is provided on a daily basis during the days that the practicum student is on-site and coverage of individual psychotherapy is provided on off-site days. Psychotherapy goals include psychoeducation, safety planning, recovery-principles, cognitive behavioral therapy, dialectical behavior therapy skills, motivational interviewing, and myriad other interventions. Psychotherapy sessions may range between minutes with most sessions occurring for about 50 minutes. Additional time may be needed in special circumstances and abbreviated session times are needed for patients for whom extended time periods would not be therapeutic (e.g., disorganized, psychotic, or behaviorally disturbed patients). Primary therapists assist in coordinating care for patients on the unit after discharge. Group Psychotherapy: Advanced practicum students are provided with training about how to facilitate group psychotherapy sessions. All group therapy is co-led with either a supervising psychologist or psychology intern in training on-site. Students will develop skills in the provision of psychotherapy groups with diverse patient populations, acute psychosis, severe depression and anxiety and dual diagnosis populations. Treatments that have been utilized include: o CBT for Insomnia (CBT-I) o DBT Skills o Illness, Management and Recovery (IMR) o Tobacco and Health o Mindfulness and Meditation o CBT for Psychosis (CBTp) o Safety Planning 5

6 Psychodiagnostic Evaluations: Advanced practicum students will complete 3 psychodiagnostic evaluations during the course of the training year including review of referral, interviewing, administration of instruments, report writing and provision of feedback. These evaluations are referred to the psychology team by the treatment teams who are seeking assistance with clarification of current risk issues and to clarify differential diagnostic questions. Common consultation requests include questions about the presence/absence of a bipolar disorder, emerging psychotic disorder, Axis II disorder, quality of obsessive-compulsive symptoms, and personality dysfunction. Evaluations are therapeutic in nature and incorporate empirically-supported instruments for assessment including structured clinical interviews (SCID), intelligence tests (WAIS-IV, WASI-II), objective personality tests (MMPI-2, PAI), cultural identity scales, symptom inventories and self-report scales. Evaluations may be completed in conjunction with a psychology intern or supervisor. Supervision Primary on-site supervision is provided by a licensed clinical psychologist, Christopher AhnAllen, Ph.D. in weekly individual supervision for a 1-hour session. Secondary supervision is provided by Victoria Choate Hasler, Ph.D. supervising psychologist for a 1-hour session. Additional supervision is provided by doctoral psychology interns who receive supervision-of-supervision by licensed psychologist staff. Case Consultation Series Practicum students attend, and may present as indicated with their treatment teams, to external case consultants who come to BWFH 2 South and provide case consultation regarding the care of current patients on the unit. These hour sessions on the unit are designed to provide training for all trainees in the 2 South setting to learn case 6

7 presentation skills, solicit answers to case consultation questions, and complement care provided on the unit. Typically, the primary therapist presents the case to the expert consultant and the session includes an in vivo interview with the patient and case consultation audience prior to a case discussion. Seminar A weekly inpatient seminar is provided for all psychology trainees and includes training activities associated with development of supervision skills, psychotherapy skills, diversity and inclusion topics, recovery-oriented care principles, and assessment. Practicum students will participate in case presentations as part of this seminar series that is led by faculty members. Additional Training Opportunities BWFH and BWH provide many additional training opportunities for psychology students. A weekly Grand Rounds program is offered by Brigham and Women s Hospital Department of Psychiatry on Thursdays at 12pm. BWFH also provides a monthly Schwartz Rounds to discuss cases of the care of individuals in the hospital from a humanitarian perspective, which typically occur on the 3 rd Wednesday at 12pm. Practicum students are welcome to attend these events. The Psychiatry Diversity and Inclusion Committee meets on a monthly basis and welcomes trainees to participate in this community including in leadership roles depending on the interest of the student. The Committee meets on the 3 rd Fridays at 12pm. 7

8 Additional ad hoc training opportunities for research collaboration with Dr. AhnAllen and Dr. Choate Hasler and other investigators may be possible during the training year including on projects of treatment outcome within inpatient settings, tobacco use in psychiatric populations, and manuscript reviews. Application: Interested doctoral students and faculty in the program are encouraged to contact Dr. Christopher AhnAllen to discuss questions about the training program. Applications for the training year are due by 12pm on January 7 th, 2019 per the Massachusetts Practicum Training Collaborative. Interested psychology graduate students should submit the following: 1. Cover letter 2. Curriculum Vitae 3. 3 Letters of reference (References should include at least one from an academic source and one from a clinical supervisor) 4. Psychological testing report (optional) Complete applications should be sent via to: Christopher AhnAllen, Ph.D. cahnallen@bwh.harvard.edu 8

9 Sample Brigham and Women s Faulkner Hospital Inpatient Psychiatry Psychosocial Programming Schedule Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday 9:00a Community Meeting 9:15a 9:15 Life Skills 9:15a Life Skills 9:15a Stress Management 9:15a Peer Support Group 9:15a Self Esteem 9:30a 9:30a Opening 10:30a 10:30a- 1 10:30a Yoga Process of Change 11:15a Sleeping Well 10:30a Yoga Tobacco & Health Intro to Mindfulness Group 11:15a DBT Skills 10:30a Exercise Group 11:15a Health/Wellness Meeting Sunday Social & Peer Support 1 Lunch Lunch Lunch Lunch Lunch Lunch Lunch Healthy Thinking Focus Group Learning to Relax Community Resource Group Self Expression OT Workshop 4:30p Safety Planning OT Workshop Personal Recovery Spirituality Pet Therapy OT Workshop Thoughts, Emotions & Behaviors Games Group Mindfulness Meditation OT Workshop 2:30p Optional Choice 2:30p Optional Choice 5:00p Dinner Dinner Dinner Dinner Dinner Dinner Dinner 7:00p 7:00p 7:15p Dual Diagnosis 7:00p Wellness Planning 7:15p Dual Diagnosis - - 9:00p 9:15p Movie 9